The Australian Immunisation Handbook 10th Edition 2013

avoid the risk of transmitting rubella to pregnant women 35 (see 3.3 Groups with
special vaccination requirements, Table 3.3.7 Recommended vaccinations for persons at
increased risk of certain occupationally acquired vaccine-preventable diseases).
Women of child-bearing age, including post-partum women
Every effort should be made to identify and immunise non-pregnant
seronegative women of child-bearing age (see ‘Serological testing for immunity
to rubella’ below). The following women are more likely to be seronegative to
rubella: women born overseas (especially in Asia, Pacific islands, sub-Saharan
Africa and South America) who entered Australia after the age of routine
vaccination; Indigenous women living in rural and remote regions; non-English
speaking women; women over the age of 35 years; and Australian-born Muslim
women. 12,13,21,36-38
Seronegative women should be given MMR vaccine and advised to avoid
pregnancy for 28 days after vaccination. Vaccinated women should be tested
for seroconversion 6 to 8 weeks after vaccination (see ‘Serological testing for
immunity to rubella’ below). Women who have negative or very low antibody
levels after vaccination should be revaccinated. However, if antibody levels
remain low after a 2nd documented vaccination, it is unlikely that further
vaccinations will improve this. 3 Further testing and vaccination is not usually
warranted; however, consultation with the laboratory that performed the
serological testing may also be helpful (see also ‘Serological testing for immunity
to rubella’ below). Negative serology after 2 documented doses of rubellacontaining
vaccine may represent a false negative (i.e. an antibody titre too low
to be detected using routine commercial assays).
Although 2 doses of MMR vaccine are routinely recommended, if rubella
immunity is demonstrated after receipt of 1 dose of a rubella-containing vaccine,
no further dose is required, unless indicated by subsequent serological testing
(see ‘Serological testing for immunity to rubella’ below) or if indicated for
protection against measles and mumps (see 4.9 Measles and 4.11 Mumps).
Women found to be seronegative on antenatal testing for rubella immunity
should be vaccinated after delivery and before discharge from the maternity
unit, as discussed above. These women should be tested for rubella immunity 6
to 8 weeks following vaccination. 1,7 (See also ‘Serological testing for immunity to
rubella’ below.)
Serological testing for immunity to rubella
Serological testing for immunity to rubella after routine vaccination of children
is not recommended. However, serological testing for rubella immunity can be
performed in cases where a history of natural immunity or 2 doses of vaccine
administration is uncertain. It is particularly important to ensure that women
of child-bearing age are immune to rubella (see ‘Women of child-bearing age,
including post-partum women’ above).
390 The Australian Immunisation Handbook 10th edition